Framework – Ethical decision making

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Ethical Principles:
A few basic principles form the basis of moral thought in healthcare:
Autonomy: Respect the uniqueness and dignity of each person, self, and others. To do good.
Nonmaleficence: Prevent/avoid harm and removal of harmful conditions.
Beneficence: Act to remove harm or promote benefit.
Justice: Treat individuals equally. Equitable distribution and allocation of resources. Fairness.
Informed consent: This is a process and right
Fidelity : Do not abandon patient, to “stay with”
Veracity: truth-telling, honesty
Framework – Ethical decision making
What is the ethical issue or problem?
• Get the facts: clinical, social, environmental, legal…
• What assumptions are being made?
• Identify ethical principles or perspectives…
What ethical principle(S) to consider? Put the issue in the form of an ethical question.
Who are the key players? What do they value?
• Who is most effected by the decision?
• Whose rights are paramount?
• Who has an interest in the outcome?
• Are there power imbalances?
• Who has the power? Should they?
Identify information gaps.
What are other information are missing that medical team should include/look at in this
case? Identify Information Gaps and find answers to those gaps.
What information sources should you consider?
• Law: Court cases, legal statutes
• Science : Best practice, “what would another reasonable practitioner do in this
situation?”
• Statistics: prognosis, outcome, complications, etc….
• Research: evidence base practice
• Social situation: family, friends….
• Culture/religion/faiths/sprits
• Finance/Socioeconomy/Education
• Document your sources and rationale.
Who is most affected by the decision?
What does that person value? Assess your values and biases and determine if and how
they are effecting your actions, judgments.
• Values held by patient, staff, institution, other stakeholders?
• Are there value conflicts? Between whom?
• Are there cultural perspectives? Who can help with these?
Identify possible courses of action and probable consequences:
• Which course is likely to be most beneficial?
• Identify potential or likely consequences of each action?
Implement the action:
• Conduct ongoing evaluation
• Does actual outcome correlate with the anticipated outcome?
• Does the same problem keep occurring? If so, why? Is this a policy issue?
Self-reflection:
• What could have been done differently?
• Should someone else have been consulted?
• What insights were gained? Should these be shared with others?
Ethical Behavior:
Values, duties, and commitments comprise personal and professional ethics.
In many professional situations it may be very clear how to take the action related to each
basic ethical principle stated in the previous section.
A few examples include:
• Respect the uniqueness and dignity of each person, self and others
– Protect patient privacy
– Treat all you encounter with respect – patients, their family members and significant
others, co-workers
– Preserve your own self-respect and dignity
• Prevent harm and removal of harmful conditions
– Intervene whenever a patient’s safety is at risk
– Promote a safe environment, both physically and psychologically
– Monitor the environment for safety hazards
• Act to remove harm or promote benefit
– Improve unsafe conditions
– Confront and report unsafe practices and errors
– Promote benefit by encouraging and assisting measures that promote healing such
as post-surgical ambulation and deep breathing, and measures that prevent harm such as
regular repositioning of patients at risk for pressure sores. These measures may be specifically
ordered to be performed at specific intervals, or it may be the healthcare professional’s
responsibility to recognize the importance of these measures and carry them out.
• Treat individuals equally
– Extend equal respect and courtesy to all individuals you encounter. Even when
treated discourteously, respond in a manner that effectively addresses the behavior without
disrespecting the other person.
A code of ethics identifies what colleagues should expect of each other within a profession and
what the public should expect from the professional.
A code of ethics is hallmark of a profession.

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